Abstract
ObjectiveWe assess change in bleeding, cramping, and IUD satisfaction among new copper (Cu) IUD users during the first six months of use, and evaluate the impact of bleeding and cramping on method satisfaction.MethodsWe recruited 77 women ages 18–45 for this prospective longitudinal observational cohort study. Eligible women reported regular menses, had no exposure to hormonal contraception in the last three months, and desired a Cu IUD for contraception. We collected data prospectively for 180 days following IUD insertion. Monthly, participants reported bleeding scores using the validated pictorial blood loss assessment chart (PBAC), IUD satisfaction using a five-point Likert scale, and cramping using a six-level ordinal scale. We used multiple imputation to address nonrandom attrition. Structural equation models for count and ordered outcomes were used to model bleeding, cramping, and IUD satisfaction growth curves over the six monthly repeated assessments.ResultsBleeding significantly decreased (approximately 23%) over the course of the study from an estimated PBAC = 195 at one month post-insertion to PBAC = 151 at six months (t = -2.38, p<0.05). Additionally, IUD satisfaction improved over time (t = 2.65, p<0.01), increasing from between “Neutral” and “Satisfied” to “Satisfied” over the six month study. Cramping decreased notably over the six month study from between biweekly and weekly, to once or twice a month (t = -4.38, p<0.001). Finally, bleeding, but not cramping, was associated with IUD satisfaction across the study (t = -2.31, p<0.05) and at study end (t = -2.81, p<0.01).ConclusionsNew Cu IUD users reported decreasing bleeding and cramping, and increasing IUD satisfaction, over the first six months. Method satisfaction was negatively associated with bleeding.
Highlights
The intrauterine device (IUD) is the most common reversible method of contraception worldwide, with its use increasing in both developed and developing countries [1,2,3]
IUD satisfaction improved over time (t = 2.65, p
The copper (CuT380A) IUD is the only non-hormonal long-acting reversible contraceptive device approved by the United States Food and Drug Administration (FDA)
Summary
The intrauterine device (IUD) is the most common reversible method of contraception worldwide, with its use increasing in both developed and developing countries [1,2,3]. 23% of contracepting women (with a range of 40%, depending on country) use either the hormonal or non-hormonal (copper) IUD [4]. The copper (CuT380A) IUD is the only non-hormonal long-acting reversible contraceptive device approved by the United States Food and Drug Administration (FDA). The copper IUD is effective to sterilization and is designed for extended use (up to twelve years) [5]. The most common reasons for discontinuation of a copper IUD during the first-year of use are symptoms related to pain or cramping and complaints of heavy bleeding [6, 7]. Perceived changes in vaginal bleeding may impact user preference, acceptability, method satisfaction and continuation [8]
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